MKSAP: 37-year-old man with low libido and fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.
On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.
Laboratory studies:
| Luteinizing hormone | 10 …
MKSAP: 37-year-old man with low libido and fatigue Overweight patients are not necessarily lazyMy nurse practitioner was pleased to see me at my annual physical this year. “So how does it feel to be 20 pounds lighter?” “It feels terrible,” I replied. Allow me to explain. Weight has been an issue my entire life. Raised on a standard Midwest diet of complex carbohydrates and the best processed delicacies that government assistance could buy, I spent most of my childhood socially segregated by my peer group due … Overweight patients are not necessarily lazy The abscess that surprised this emergency physicianI carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.” One of them held the small urine jar up to a light and began unscrewing the lid. “Don’t!” I said. “Why not?” “It stinks. You wouldn’t believe how much it stinks. We … The abscess that surprised this emergency physician CSF is soap for your brainRecently after pulling a couple 20-hour shifts, people kept encouraging me to sleep on my break. They were obviously concerned for my well-being but it got me thinking more about the role sleep plays in our lives. If the average life expectancy is 78 then we spend 30 percent of our lives asleep which is also the same amount we spend in our cars commuting, and a meager 0.16 percent … The unhappy couples after a cancer diagnosis
The unhappy couples after a cancer diagnosis 5 ways to tell if a practice has integrityI stood in line behind a physician, slightly balding and in a long, starched lab coat at the coffee shop in our hospital. As he paid and took his coffee, I noticed that he smiled and called the clerk by name, “Thank you, Terri.” He went on about his day, and I was left to wonder about the man, his practice and what type of person he was. My friend has … 5 ways to tell if a practice has integrity MKSAP: 28-year-old man is evaluated for recurrent nephrolithiasisTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he has been adherent to a … MKSAP: 28-year-old man is evaluated for recurrent nephrolithiasis An ode to the nurse who saved Jimmy Kimmel’s babyRecently, a nurse at Children’s Hospital Los Angeles noticed that comedian Jimmy Kimmel’s newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby’s life. Here’s what the public doesn’t understand: Nurses do this every day. … An ode to the nurse who saved Jimmy Kimmel’s baby This gynecological issue is misdiagnosed over 50 percent of the timeAs a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses … This gynecological issue is misdiagnosed over 50 percent of the time There she was, hanging in our closetNo matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight. That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali … There she was, hanging in our closet Beware of worthless procedures and epidural steroids for your back painAn excerpt from Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery. Near my office, there’s a breakfast-and-lunch joint where strangers sit down at shared tables. When Joseph, an attorney … Beware of worthless procedures and epidural steroids for your back pain MKSAP: 29-year-old woman with nodules over her lower extremitiesTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications. On … MKSAP: 29-year-old woman with nodules over her lower extremities MKSAP: 68-year-old man with new-onset ascitesTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, … MKSAP: 68-year-old man with new-onset ascites Normal aging: A steady loss of organ and process functionPart of a series. The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again. There are many … Normal aging: A steady loss of organ and process function How useful is a cardiac calcium CT scan?Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium … How useful is a cardiac calcium CT scan? The suicide rate is increasing. Why is that?Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades … The suicide rate is increasing. Why is that? MKSAP: 79-year-old man with right hip painTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that … MKSAP: 79-year-old man with right hip pain This is what heroin addiction looks likeWhat can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration. Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were … This is what heroin addiction looks like MKSAP: 52-year-old man with sudden onset of erectile dysfunctionTest your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly … MKSAP: 52-year-old man with sudden onset of erectile dysfunction Let older people talk about sexHe was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to … Let older people talk about sex
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